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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF07

F07

Billable

Personality and behavioral disorders due to known physiological condition

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F07 is a billable code used to indicate a diagnosis of personality and behavioral disorders due to known physiological condition.

Key Diagnostic Point:

F07 encompasses personality and behavioral disorders that arise as a direct result of a known physiological condition. These disorders can manifest in various ways, including changes in personality traits, mood disturbances, and alterations in behavior that are attributable to underlying medical issues such as neurological disorders, metabolic imbalances, or chronic illnesses. Common examples include personality changes following traumatic brain injury, dementia, or severe metabolic disorders. Clinicians must carefully assess the patient's medical history and current physiological state to determine the extent to which these factors contribute to the observed behavioral changes. Accurate diagnosis is crucial, as it informs treatment strategies that may involve both medical and psychological interventions. The interplay between physiological conditions and behavioral symptoms can complicate the clinical picture, necessitating a multidisciplinary approach to care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary psychiatric disorders and those secondary to physiological conditions.
  • Need for comprehensive medical history to establish causality.
  • Variability in presentation based on the underlying physiological condition.
  • Potential overlap with other mental health diagnoses.

Audit Risk Factors

  • Inadequate documentation linking the physiological condition to behavioral changes.
  • Misclassification of primary versus secondary disorders.
  • Failure to update codes as the patient's condition evolves.
  • Lack of interdisciplinary communication in documentation.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological assessments and imaging results.

Common Clinical Scenarios

Patients with traumatic brain injuries exhibiting personality changes.

Billing Considerations

Ensure clear documentation of neurological findings correlating with behavioral symptoms.

Psychiatry

Documentation Requirements

Comprehensive psychiatric evaluations and history of present illness.

Common Clinical Scenarios

Patients with dementia showing significant personality changes.

Billing Considerations

Document the timeline of personality changes in relation to the onset of the physiological condition.

Coding Guidelines

Inclusion Criteria

Use F07 When
  • According to ICD
  • 10 guidelines, F07 should be used when there is clear evidence that the personality and behavioral disorder is a direct result of a known physiological condition
  • Coders must ensure that the documentation supports this relationship and that other potential causes are ruled out

Exclusion Criteria

Do NOT use F07 When
No specific exclusions found.

Related CPT Codes

90791CPT Code

Psychiatric diagnostic evaluation

Clinical Scenario

Used when assessing a patient with personality changes due to a physiological condition.

Documentation Requirements

Comprehensive evaluation notes including history and mental status exam.

Specialty Considerations

Psychiatrists should document the relationship between the physiological condition and behavioral symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of personality and behavioral disorders related to physiological conditions, improving the accuracy of diagnoses and treatment plans. This specificity aids in better understanding the prevalence and impact of these disorders in clinical practice.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of personality and behavioral disorders related to physiological conditions, improving the accuracy of diagnoses and treatment plans. This specificity aids in better understanding the prevalence and impact of these disorders in clinical practice.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of personality and behavioral disorders related to physiological conditions, improving the accuracy of diagnoses and treatment plans. This specificity aids in better understanding the prevalence and impact of these disorders in clinical practice.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What types of physiological conditions can lead to F07?

F07 can be associated with a variety of physiological conditions, including neurological disorders (like traumatic brain injury or dementia), metabolic disorders (such as thyroid dysfunction), and chronic illnesses (like cancer or chronic kidney disease) that affect brain function and behavior.